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An audit on compliance to the liver lesion investigation pathway for suspected hepatocellular carcinoma.
EP34297
Poster Title: An audit on compliance to the liver lesion investigation pathway for suspected hepatocellular carcinoma.
Submitted on 29 Oct 2020
Author(s): Saigeet Eleti, Natasha Davendralingam, Asanda Koza, Geoffrey Lie, Sonali Shah, Essam Lakha, Mahrukh Qureshi
Affiliations: Barts Health NHS Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 488
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Poster Information
Abstract: Purpose
Liver cancer is associated with significant morbidity and mortality globally, representing the third highest cause of cancer-related death (1). Hepatocellular carcinoma (HCC) constitutes over 90% of primary liver malignancies and is rising in incidence (2). Early diagnosis of HCC produces significant improvements in five-year survival rates (3). Therefore, we aimed to assess compliance at our centre to the standards for liver lesion investigation established by EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma (2018).

Methods
Retrospective data collection was performed from electronic patient records and picture archiving and communications system (PACS) to identify patients with imaging-confirmed suspicious liver lesions which were ultimately diagnosed as hepatocellular carcinoma within the 2016 – 2020 period. We identified the sequence of imaging investigations that patients underwent until diagnosis was established.

Results
Of the 77 patients identified that met our criteria, 39 (50.6%) had cirrhotic livers and 38 (49.4%) had non-cirrhotic livers. The overall compliance was 73% (56/77). The compliance for cirrhotic patients was 79.5% (31/39) and for non-cirrhotic patients was 65.8% (25/38). Primary reasons for non-compliance included lack of biopsy where indicated (12/21) and inadequate dedicated imaging (5/21).

Conclusions
Overall compliance of 73% suggests scope for improvement which could be achieved by addressing key areas identified in our audit. A change in policy on biopsy in non-cirrhotic patients to achieve definitive diagnosis would align with EASL–EORTC guidelines. Increased use of further dedicated imaging, such as contrast enhanced ultrasound (4), where initial imaging demonstrates atypical findings would establish a more robust imaging pathway.
Summary: An audit to investigate the compliance to the liver lesion investigation pathway at our centre in patients that had biopsy proven hepatocellular carcinoma.References: References
1. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35:421–430.
2. Parkin DM, Bray F, Ferlay J et-al. Estimating the world cancer burden: Globocan 2000. Int. J. Cancer. 2001;94 (2): 153-6. Int. J. Cancer
3. Bruix J., Sherman M. Management of hepatocellular carcinoma: An update. Hepatology. 2011;53:1020–1022.
4. SonoVue (sulphur hexafluoride microbubbles) – contrast agent for contrast-enhanced ultrasound imaging of the liver | Guidance | NICE; [cited 2020 Jul 16]. Available from: https://www.nice.org.uk/guidance/dg5/history
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